NU 372 - Exam 2 Practice Questions With
Complete Solutions
A 26-year-old woman has been diagnosed with
early systemic lupus erythematosus (SLE) involving
her joints. In teaching the patient about the
disease, the nurse includes the information that
SLE is a(n): A. Hereditary disorder of women but
usually does not show clinical symptoms unless a
woman becomes pregnant.
B. Autoimmune disease of women in which
antibodies are formed that destroy all nucleated
cells in the body.C. Disorder of immune function,
but it is extremely variable in its course, and there
is no way to predict its progression.
D. Disease that causes production of antibodies
that bind with cellular estrogen receptors, causing
an inflammatory response. Correct Answers
Answer: C. Rationale: SLE has an unpredictable
course, even with appropriate treatment. Women
are more at risk for SLE, but it is not confined
exclusively to women. Clinical symptoms may
worsen during pregnancy but are not confined to
pregnancy or the perinatal period. All nucleated
cells are not destroyed by the antinuclear
antibodies. The inflammation in SLE is not caused
by antibody binding to cellular estrogen receptors.
A client is diagnosed with human
immunodeficiency virus (HIV) infection. The nurse
,prepares a care plan for the client, knowing that
HIV is primarily a condition in which:
a) immunosuppression occurs and is indicated by a
T4 lymphocyte count of less than 200/mm3
b) bacterial infection occurs, causing weakness
c) fungal infection occurs, causing a rash and
pruritus
d) protozoan infection occurs, causing a fever and
nonproductive cough Correct Answers A. HIV
infection causes immunosuppression and is
indicated by a T4 lymphocyte count of less than
200/mm3. Although bacterial, fungal, and protozoal
infection can occur, these occur as opportunistic
infections as a result of the immunosuppression.
A client is in the acute phase of rheumatoid
arthritis. Which of the following should the nurse
identify as lowest priority in the plan of care?
1. Relieving pain.
2. Preserving joint function.
3. Maintaining usual ways of accomplishing tasks.
4. Preventing joint deformity. Correct Answers 3.
Maintaining usual ways of accomplishing tasks
would be the lowest priority during the acute
phase. Rather, the focus is on developing less
stressful ways of accomplishing routine tasks. Pain
relief is a high priority during the acute phase
because pain is typically severe and interferes with
the client's ability to function. Preserving joint
function and preventing joint deformity are high
,priorities during the acute phase to promote an
optimal level of functioning and reduce the risk of
contractures.
A client is suspected of having systemic lupus
erythematous. The nurse monitors the client,
knowing that which of the following is one of the
initial characteristic sign of systemic lupus
erythematous?
A. Weight gain
B. Subnormal temperature
C. Elevated red blood cell count
D. Rash on the face across the bridge of the nose
Correct Answers Answer: D. Rationale: Skin lesions
or rash on the face across the bridge of the nose
and on the cheeks is an initial characteristic sign of
systemic lupus erythematosus (SLE). Fever and
weight loss may also occur. Anemia is most likely
to occur later in SLE.
A client with a fever is admitted for dehydration.
Which information should the nurse use to help
determine the cause of this client's fever? (Select
all that apply.)
A. Amount of alcohol ingested daily
B. Health history
C. Employment status
D. History of substance use
E. Client age Correct Answers B. Health history
E. Client age
, Rationale: The amount of collaborative care for a
client with hyperthermia will depend on the
underlying reason for the fever. This includes
studying the client's age and health history.
Employment status, history of substance use, and
amount of alcohol ingested are areas within the
client's lifestyle and do not necessarily impact the
client's health history.
A homeless person is brought to the emergency
department after prolonged exposure to cold
weather. The nurse would assess the patient for
manifestations of hypothermia, including
A. Stupor.
B. Erythema.
C. Increased anxiety.
D. Rapid respirations. Correct Answers A. Stupor.
Stupor may occur with hypothermia because of
slowed cerebral metabolic processes. Pallor, not
erythema, would be present as a result of
peripheral vasoconstriction. Drowsiness occurs; the
patient would be unable to focus on anxiety-
producing aspects of the situation. Respirations
would be decreased.
A massive gastrointestinal bleed has resulted in
hypovolemic shock in an older patient. What is a
priority nursing diagnosis?
a-Acute pain
b-Impaired tissue integrity
Complete Solutions
A 26-year-old woman has been diagnosed with
early systemic lupus erythematosus (SLE) involving
her joints. In teaching the patient about the
disease, the nurse includes the information that
SLE is a(n): A. Hereditary disorder of women but
usually does not show clinical symptoms unless a
woman becomes pregnant.
B. Autoimmune disease of women in which
antibodies are formed that destroy all nucleated
cells in the body.C. Disorder of immune function,
but it is extremely variable in its course, and there
is no way to predict its progression.
D. Disease that causes production of antibodies
that bind with cellular estrogen receptors, causing
an inflammatory response. Correct Answers
Answer: C. Rationale: SLE has an unpredictable
course, even with appropriate treatment. Women
are more at risk for SLE, but it is not confined
exclusively to women. Clinical symptoms may
worsen during pregnancy but are not confined to
pregnancy or the perinatal period. All nucleated
cells are not destroyed by the antinuclear
antibodies. The inflammation in SLE is not caused
by antibody binding to cellular estrogen receptors.
A client is diagnosed with human
immunodeficiency virus (HIV) infection. The nurse
,prepares a care plan for the client, knowing that
HIV is primarily a condition in which:
a) immunosuppression occurs and is indicated by a
T4 lymphocyte count of less than 200/mm3
b) bacterial infection occurs, causing weakness
c) fungal infection occurs, causing a rash and
pruritus
d) protozoan infection occurs, causing a fever and
nonproductive cough Correct Answers A. HIV
infection causes immunosuppression and is
indicated by a T4 lymphocyte count of less than
200/mm3. Although bacterial, fungal, and protozoal
infection can occur, these occur as opportunistic
infections as a result of the immunosuppression.
A client is in the acute phase of rheumatoid
arthritis. Which of the following should the nurse
identify as lowest priority in the plan of care?
1. Relieving pain.
2. Preserving joint function.
3. Maintaining usual ways of accomplishing tasks.
4. Preventing joint deformity. Correct Answers 3.
Maintaining usual ways of accomplishing tasks
would be the lowest priority during the acute
phase. Rather, the focus is on developing less
stressful ways of accomplishing routine tasks. Pain
relief is a high priority during the acute phase
because pain is typically severe and interferes with
the client's ability to function. Preserving joint
function and preventing joint deformity are high
,priorities during the acute phase to promote an
optimal level of functioning and reduce the risk of
contractures.
A client is suspected of having systemic lupus
erythematous. The nurse monitors the client,
knowing that which of the following is one of the
initial characteristic sign of systemic lupus
erythematous?
A. Weight gain
B. Subnormal temperature
C. Elevated red blood cell count
D. Rash on the face across the bridge of the nose
Correct Answers Answer: D. Rationale: Skin lesions
or rash on the face across the bridge of the nose
and on the cheeks is an initial characteristic sign of
systemic lupus erythematosus (SLE). Fever and
weight loss may also occur. Anemia is most likely
to occur later in SLE.
A client with a fever is admitted for dehydration.
Which information should the nurse use to help
determine the cause of this client's fever? (Select
all that apply.)
A. Amount of alcohol ingested daily
B. Health history
C. Employment status
D. History of substance use
E. Client age Correct Answers B. Health history
E. Client age
, Rationale: The amount of collaborative care for a
client with hyperthermia will depend on the
underlying reason for the fever. This includes
studying the client's age and health history.
Employment status, history of substance use, and
amount of alcohol ingested are areas within the
client's lifestyle and do not necessarily impact the
client's health history.
A homeless person is brought to the emergency
department after prolonged exposure to cold
weather. The nurse would assess the patient for
manifestations of hypothermia, including
A. Stupor.
B. Erythema.
C. Increased anxiety.
D. Rapid respirations. Correct Answers A. Stupor.
Stupor may occur with hypothermia because of
slowed cerebral metabolic processes. Pallor, not
erythema, would be present as a result of
peripheral vasoconstriction. Drowsiness occurs; the
patient would be unable to focus on anxiety-
producing aspects of the situation. Respirations
would be decreased.
A massive gastrointestinal bleed has resulted in
hypovolemic shock in an older patient. What is a
priority nursing diagnosis?
a-Acute pain
b-Impaired tissue integrity
